Departments of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
Departments of Medicine, Case Western Reserve University, Cleveland, Ohio, USA; Division of Cardiovascular Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
JACC Clin Electrophysiol. 2021 Jul;7(7):909-919. doi: 10.1016/j.jacep.2020.12.010. Epub 2021 Feb 24.
This study was to test the hypotheses that: 1) when using phase analysis, repetitive Wannabe re-entry produces a phase singularity point (i.e., a rotor); and 2) the location of the stable rotor is close to the focal source.
Recent contact mapping studies in patients with persistent atrial fibrillation (AF) demonstrated that phase analysis produced a different mechanistic result than classical activation sequence analysis. Our studies in patients with persistent AF showed that focal sources sometimes produced repetitive Wannabe re-entry, that is, incomplete re-entry.
During open heart surgery, we recorded activation from both atria simultaneously using 510 to 512 electrodes in 12 patients with persistent AF. We performed activation sequence mapping and phase analyses on 4 s of mapped data. For each detected stable rotor (>2 full rotations [720°] recurring at the same site), the corresponding activation patterns were examined from the activation sequence maps.
During AF, phase singularity points (rotors) were identified in both atria in all patients. However, stable phase singularity points were only present in 6 of 12 patients. The range of stable phase singularity points per patient was 0 to 6 (total 14). Stable phase singularity points were produced due to repetitive Wannabe re-entry generated from a focal source or by passive activation. A conduction block sometimes created a stable phase singularity point (n = 2). The average distance between a focal source and a stable rotor was 0.9 ± 0.3 cm.
Repetitive Wannabe re-entry generated stable rotors adjacent to a focal source. No true re-entry occurred.
本研究旨在验证以下两个假设：1）在应用相位分析时，重复 wannabe 折返会产生相位奇异点（即转子）；2）稳定转子的位置接近焦点源。
最近对持续性心房颤动（AF）患者的接触映射研究表明，相位分析产生的机制结果与经典激活序列分析不同。我们对持续性 AF 患者的研究表明，焦点源有时会产生重复 wannabe 折返，即不完全折返。
在心脏直视手术中，我们使用 12 例持续性 AF 患者的 510 至 512 个电极同时记录双侧心房的激活。我们对 4 秒的映射数据进行激活序列映射和相位分析。对于每个检测到的稳定转子（在同一部位重复 2 次以上[720°]），从激活序列图中检查相应的激活模式。
在 AF 期间，所有患者的双侧心房均识别到相位奇异点（转子）。然而，只有 6 例患者存在稳定的相位奇异点。每位患者稳定相位奇异点的范围为 0 至 6（共 14 个）。稳定的相位奇异点是由焦点源产生的重复 wannabe 折返或被动激活产生的。传导阻滞有时会产生稳定的相位奇异点（n=2）。焦点源和稳定转子之间的平均距离为 0.9±0.3cm。
重复 wannabe 折返产生稳定的转子，其位置紧邻焦点源。没有真正的折返发生。
